Provider Demographics
NPI:1083775092
Name:GOLDSTEIN, PAULA IRIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:IRIS
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BIRCHWOOD CT
Mailing Address - Street 2:4E
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4531
Mailing Address - Country:US
Mailing Address - Phone:516-742-5687
Mailing Address - Fax:516-742-5687
Practice Address - Street 1:3 BIRCHWOOD CT
Practice Address - Street 2:4E
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4511
Practice Address - Country:US
Practice Address - Phone:516-742-5687
Practice Address - Fax:516-742-5687
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047826-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND7892Medicare ID - Type UnspecifiedSOCIAL WORKER